Comparison of the Outcomes of Microendoscopic Discectomy Versus Full-Endoscopic Discectomy for the Treatment of L4/5 Lumbar Disc Herniation

Fujita, Muneyoshi; Inui, Takahiro; Oshima, Yasushi; Iwai, Hiroki; Inanami, Hirohiko; Koga, Hisashi

doi:10.1177/21925682221127997

Cited by 7 publications

(4 citation statements)

References 30 publications

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“…However, it should be noted that the duration depends on multiple factors, including the expertise of the operating surgeon, whether the surgeon performs a sequestrectomy or discectomy, whether the recurrence is on the same side as the previous surgery or on the opposite side, etc. [ 27 ]. Intraoperative blood loss can be a concern in repeat surgery.…”

Section: Discussionmentioning

confidence: 99%

Repeat Discectomy for the Management of Same-Level Recurrent Disc Herniation: A Study of 50 Patients

Musa,

Makirov,

Susin

et al. 2023

Cureus

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Background Same-level recurrent disc herniation remains a challenge in spine surgery. Although most surgeons agree on discectomy as the treatment of choice for primary lumbar disc herniation, the management of recurrent disc herniation remains ambiguous and largely depends on the operating surgeon. Many surgeons recommend repeat discectomy over fusion because it is cheaper and less invasive. In this study, we analyzed 50 patients who underwent a repeat discectomy. Materials and methods The patients in the study had previously been managed for lumbar disc herniation and then presented with either recurrent same-level herniation or symptoms attributed to the same level. The patients were then managed with a repeat discectomy without fusion. We analyzed the preoperative and postoperative Oswestry Disability Index (ODI), duration of surgery, blood loss, duration of hospitalization, and complications. Results Fifty patients were included: 27 females (54%), and 23 males (46%). They were followed up for an average of 2.81 years (range: 1-4). The mean duration of hospitalization was 4.06 ± 1.5 days (range: 2-8). The operative time was 104.60 minutes (range: 50-195), with an intraoperative blood loss of 85.40 mL (range: 50-150 mL). Durotomy occurred as a complication in eight (16%) patients. The recurrence rate was 26%, with 36% progressing to fusion. The change in preoperative ODI and postoperative ODI was 20.94 ± 7.24 (6-37), with a p-value of 0.04. There were no long-term complications recorded. Conclusion Repeat discectomy is a good management option for same-level recurrent disc herniation. The procedure is associated with low intraoperative blood loss and a short operating time, but there is a significant risk of durotomy. The risk of recurrence remains a concern due to the progression of degenerative changes, especially in the presence of Modic-2 changes. These advantages and disadvantages should be discussed with patients.

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Section: Discussionmentioning

confidence: 99%

Repeat Discectomy for the Management of Same-Level Recurrent Disc Herniation: A Study of 50 Patients

Musa,

Makirov,

Susin

et al. 2023

Cureus

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“…Following the upper limit of the 95% CI for the mean difference in VAS and ODI scores, our intention-to-treat analysis demonstrated that IELD was considered noninferior to MLD in terms terms of a shorter length of stay and reduced blood loss, consistent with previous different approach study. [37][38][39][40] However, the operation time is longer compared to the MLD procedure. The difference operation time between the 2 procedures were attributed to the distinct nature of both surgical procedures, such as patient-specific factors, equipment used, or the skill and experience of the surgeon.…”

Section: Discussionmentioning

confidence: 99%

Interlaminar Endoscopic Lumbar Discectomy Versus Microscopic Lumbar Discectomy: A Preliminary Analysis of L5–S1 Lumbar Disc Herniation Outcomes in Prospective Randomized Controlled Trials

Liu,

Kim,

Park

et al. 2023

Neurospine

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Objective: A preliminary report from a single institution, noninferiority, prospective randomized controlled trial is conducted to determine the effectiveness of interlaminar endoscopic lumbar discectomy (IELD) versus microscopic lumbar discectomy (MLD) for the treatment of L5–S1 lumbar disc herniation (LDH).Methods: This prospective, noncrossover, randomized controlled trials was conducted at a single neurosurgical center. Patients with symptomatic radiculopathy or intermittent neurogenic claudication caused by LDH were enrolled from July 2016 to July 2021. The study compared the effectiveness of microscopic and full-endoscopic discectomy procedures. Outcome measures included visual analogue scale (VAS) scores for back and leg pain, Oswestry Disability Index scores, radiologic measurements, endurance time of walking, and satisfaction rate.Results: Of 37 assessed patients, both IELD and MLD groups demonstrated significant improvements in VAS scores for pain over time, with no significant difference between them. For secondary outcomes, the IELD group had a shorter hospital stay and reduced blood loss but a longer operation time than the MLD group. Radiographic evaluations showed no change compared to preoperative data. Patient satisfaction and recovery rates were slightly higher for the MLD group, but both groups were comparable in most evaluations, with complications being minimal.Conclusion: The IELD was noninferior in improving the intensity of back and leg pain and functional disability, compared to the MLD. Additionally, the IELD showed no difference in clinical outcomes for patients in terms of radiographic results and patient satisfaction rates. The results of this research preliminarily demonstrate that the IELD could be considered an effective alternative to MLD for L5–S1 central or paracentral LDH.

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“…[ 1 , 8 ] Although repeat discectomy alone has several advantages (i.e., less invasive, shorter hospital stay, and reduced cost), a subset of up to 25% of these patients may later develop instability warranting fusions. [ 2 , 6 , 9 ] Here, we reviewed the literature over the past 5 years for treating recurrent lumbar discs with repeated diskectomy alone.…”

Section: Introductionmentioning

confidence: 99%

Repeat discectomy for recurrent same level disc herniation: A literature review of the past 5 years

Musa

Barrientos

Макиров³

et al. 2023

Surgical Neurology International

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Background: Recurrent disc herniations remain a challenge in spinal surgery. Although some authors recommend a repeat discectomy, others offer more invasive secondary fusions. Here, we reviewed the literature (2017–2022) regarding the safety/efficacy of treating recurrent disc herniations with repeated discectomy alone. Methods: Our literature search of recurrent lumbar disc herniations included; Medline, PubMed, Google scholar, and the Cochrane database. We focused on the types of discectomy performed, perioperative morbidity, costs, length of surgery, pain scores, and incidence of secondary dural tears. Results: We identified 769 cases that included 126 microdiscectomies, and 643 endoscopic discectomies. Rates of disc recurrence ranged from 1% to 25% with accompanying secondary durotomy varying from 2% to 15%. In addition, operative times were relatively short, ranging from 29.2 min to 125 min, with a relatively small average estimated blood loss (i.e., minimal to maximally 150 mls). Conclusion: Repeated discectomy was the most commonly performed treatment for same-level recurrent disc herniations. Despite minimal intraoperative blood loss and short operating times, there was a significant risk of durotomy. Notably, patients must be informed that more extensive bone removal for treating recurrent disc increases the risk for instability warranting subsequent fusion.

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Comparison of the Outcomes of Microendoscopic Discectomy Versus Full-Endoscopic Discectomy for the Treatment of L4/5 Lumbar Disc Herniation

Cited by 7 publications

References 30 publications

Repeat Discectomy for the Management of Same-Level Recurrent Disc Herniation: A Study of 50 Patients

Repeat Discectomy for the Management of Same-Level Recurrent Disc Herniation: A Study of 50 Patients

Interlaminar Endoscopic Lumbar Discectomy Versus Microscopic Lumbar Discectomy: A Preliminary Analysis of L5–S1 Lumbar Disc Herniation Outcomes in Prospective Randomized Controlled Trials

Repeat discectomy for recurrent same level disc herniation: A literature review of the past 5 years

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